The Impact of Mechanical Power Normalized to Predicted Body Weight on Outcomes in Pediatric ARDSTake-Home Points
Background: The topic of mechanical power (MP) in pediatric ARDS (PARDS) is not well explored in the current literature, limiting our understanding of its potentially detrimental effect. Research Question: What is the association between MP and clinical outcomes, and does impairment in oxygenation m...
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Elsevier
2025-09-01
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2949788425000358 |
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| author | Herng Lee Tan, MSc Rehena Sultana, MSc(stat) Phuc Huu Phan, MD Muralidharan Jayashree, MD Hongxing Dang, MD Soo Lin Chuah, MBBS Chin Seng Gan, MBBS Siew Wah Lee, MD Karen Ka Yan Leung, MBBS, MSc Ellis Kam Lun Hon, MBBS, MD Xuemei Zhu, MD Pei Chuen Lee, MMed(Paeds) Chian Wern Tai, MD Jacqueline Soo May Ong, MB BChir Lijia Fan, MD Kah Min Pon, MD Li Huang, MD Kazunori Aoki, MD Hiroshi Kurosawa, MD, PhD Rujipat Samransamruajkit, MD Jia Yueh Chong, MD Felix Liauw, MD Nattachai Anantasit, MD Wei Xu, MD Chunfeng Liu, MD Jan Hau Lee, MBBS Louise Ngu, MB BCh BAO Yek Kee Chor, MD Suparyatha Ida Bagus Gede, MD Dyah Kanya Wati, MD Judith Ju Ming Wong, MB BCh BAO |
| author_facet | Herng Lee Tan, MSc Rehena Sultana, MSc(stat) Phuc Huu Phan, MD Muralidharan Jayashree, MD Hongxing Dang, MD Soo Lin Chuah, MBBS Chin Seng Gan, MBBS Siew Wah Lee, MD Karen Ka Yan Leung, MBBS, MSc Ellis Kam Lun Hon, MBBS, MD Xuemei Zhu, MD Pei Chuen Lee, MMed(Paeds) Chian Wern Tai, MD Jacqueline Soo May Ong, MB BChir Lijia Fan, MD Kah Min Pon, MD Li Huang, MD Kazunori Aoki, MD Hiroshi Kurosawa, MD, PhD Rujipat Samransamruajkit, MD Jia Yueh Chong, MD Felix Liauw, MD Nattachai Anantasit, MD Wei Xu, MD Chunfeng Liu, MD Jan Hau Lee, MBBS Louise Ngu, MB BCh BAO Yek Kee Chor, MD Suparyatha Ida Bagus Gede, MD Dyah Kanya Wati, MD Judith Ju Ming Wong, MB BCh BAO |
| author_sort | Herng Lee Tan, MSc |
| collection | DOAJ |
| description | Background: The topic of mechanical power (MP) in pediatric ARDS (PARDS) is not well explored in the current literature, limiting our understanding of its potentially detrimental effect. Research Question: What is the association between MP and clinical outcomes, and does impairment in oxygenation mediate the association between MP and clinical outcomes? Study Design and Methods: This post hoc causal mediation analysis of data from a before-and-after study recruited children with PARDS from 21 PICUs. We used a simplified MP calculation for pressure-controlled and volume-controlled ventilation normalized to predicted body weight. We identified low, moderate, and high MP cutoffs and used multivariable regression to determine the association between MP categories on ICU mortality, 28-day ventilator-free days (VFDs) and ICU-free days (IFDs), adjusting for the Pediatric Index of Mortality 3 score, Pediatric Logistic Organ Dysfunction 2 score, oxygenation index (OI), and age. Causal mediation analysis was performed to estimate the causal effect of MP on outcomes treating oxygenation impairment (represented by OI) as mediator and age as a confounder. Results: A total of 466 patients were included for this analysis. Cutoffs for low, moderate, and high MP were < 0.2262 J/min/kg, 0.2262 to 0.4487 J/min/kg, and > 0.4487 J/min/kg, respectively. High vs low MP was associated with reduced VFDs (adjusted incidence rate ratio, –0.22 [95% CI, –0.35 to –0.10]; P < .001) and IFDs (adjusted incidence rate ratio, –0.14 [95% CI, –0.27 to –0.01]; P = .034), but not ICU mortality. In the causal analysis, OI showed a significant indirect effect on the causal pathway of MP on VFDs (indirect effect, –4.30 [P < .001]; direct effect, –1.17 [P = .635]; total effect, –5.47 [P = .024]) and IFDs [indirect effect, –3.13 [P < .001]; direct effect, –0.72 [P = .635]; total effect, –3.84 [P = .024]), but not ICU mortality. Interpretation: In this study, higher MP was associated with fewer VFDs and IFDs. The causal effect of MP on VFDs and IFDs was mediated fully by the impairment in oxygenation. |
| format | Article |
| id | doaj-art-bf1da2f2f98a460294630977b328af6f |
| institution | Kabale University |
| issn | 2949-7884 |
| language | English |
| publishDate | 2025-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | CHEST Critical Care |
| spelling | doaj-art-bf1da2f2f98a460294630977b328af6f2025-08-20T03:24:59ZengElsevierCHEST Critical Care2949-78842025-09-013310016210.1016/j.chstcc.2025.100162The Impact of Mechanical Power Normalized to Predicted Body Weight on Outcomes in Pediatric ARDSTake-Home PointsHerng Lee Tan, MSc0Rehena Sultana, MSc(stat)1Phuc Huu Phan, MD2Muralidharan Jayashree, MD3Hongxing Dang, MD4Soo Lin Chuah, MBBS5Chin Seng Gan, MBBS6Siew Wah Lee, MD7Karen Ka Yan Leung, MBBS, MSc8Ellis Kam Lun Hon, MBBS, MD9Xuemei Zhu, MD10Pei Chuen Lee, MMed(Paeds)11Chian Wern Tai, MD12Jacqueline Soo May Ong, MB BChir13Lijia Fan, MD14Kah Min Pon, MD15Li Huang, MD16Kazunori Aoki, MD17Hiroshi Kurosawa, MD, PhD18Rujipat Samransamruajkit, MD19Jia Yueh Chong, MD20Felix Liauw, MD21Nattachai Anantasit, MD22Wei Xu, MD23Chunfeng Liu, MD24Jan Hau Lee, MBBS25Louise Ngu, MB BCh BAO26Yek Kee Chor, MD27Suparyatha Ida Bagus Gede, MD28Dyah Kanya Wati, MD29Judith Ju Ming Wong, MB BCh BAO30Respiratory Therapy Service, Division of Allied Health Specialties, KK Women’s and Children’s Hospital, Singapore; Children’s Intensive Care Unit, Department of Pediatric Subspecialties, KK Women’s and Children’s Hospital, SingaporeCenter for Quantitative Medicine, Duke-NUS Medical School, SingaporeVietnam National Children’s Hospital, Hanoi, VietnamPostgraduate Institute of Medical Education and Research, Chandigarh, IndiaChildren’s Hospital of Chongqing Medical University, Chongqing, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, ChinaUniversity Malaya Medical Centre, Kuala Lumpur, MalaysiaUniversity Malaya Medical Centre, Kuala Lumpur, MalaysiaSultanah Aminah Hospital, Johor, Malaysia; Hospital Tengku Ampuan Rahimah, Selangor, MalaysiaPaediatric Intensive Care Unit, Hong Kong Children’s Hospital, Special Administrative Region in China, ChinaPaediatric Intensive Care Unit, Hong Kong Children’s Hospital, Special Administrative Region in China, ChinaChildren’s Hospital of Fudan University, Shanghai, ChinaUniversiti Kebangsaan Malaysia Specialist Children’s Hospital, Kuala Lumpur, MalaysiaUniversiti Kebangsaan Malaysia Specialist Children’s Hospital, Kuala Lumpur, MalaysiaDivision of Paediatric Critical Care, National University Hospital, SingaporeDivision of Paediatric Critical Care, National University Hospital, SingaporePenang General Hospital, Penang, MalaysiaDepartment of Emergency, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, ChinaHyogo Prefectural Kobe Children’s Hospital, Hyogo, JapanHyogo Prefectural Kobe Children’s Hospital, Hyogo, JapanDivision of Pediatric Critical Care, King Chulalongkorn Memorial Hospital, Bangkok, ThailandHospital Tunku Azizah Kuala Lumpur, Kuala Lumpur, MalaysiaHarapan Kita National Women and Children Health Center, Jakarta, IndonesiaRamathibodi Hospital, Bangkok, ThailandShengjing Hospital of China Medical University, Liaoning, ChinaShengjing Hospital of China Medical University, Liaoning, ChinaChildren’s Intensive Care Unit, Department of Pediatric Subspecialties, KK Women’s and Children’s Hospital, Singapore; Duke-NUS Medical School, SingaporeSarawak General Hospital, Sarawak, MalaysiaSarawak General Hospital, Sarawak, MalaysiaPediatric Emergency and Intensive Care Unit, Prof I.G.N.G Ngoerah Hospital, Bali, Indonesia; Medical Faculty, Udayana University, Bali, IndonesiaPediatric Emergency and Intensive Care Unit, Prof I.G.N.G Ngoerah Hospital, Bali, Indonesia; Medical Faculty, Udayana University, Bali, IndonesiaChildren’s Intensive Care Unit, Department of Pediatric Subspecialties, KK Women’s and Children’s Hospital, Singapore; Duke-NUS Medical School, Singapore; CORRESPONDENCE TO: Judith Ju Ming Wong, MBBCh BAOBackground: The topic of mechanical power (MP) in pediatric ARDS (PARDS) is not well explored in the current literature, limiting our understanding of its potentially detrimental effect. Research Question: What is the association between MP and clinical outcomes, and does impairment in oxygenation mediate the association between MP and clinical outcomes? Study Design and Methods: This post hoc causal mediation analysis of data from a before-and-after study recruited children with PARDS from 21 PICUs. We used a simplified MP calculation for pressure-controlled and volume-controlled ventilation normalized to predicted body weight. We identified low, moderate, and high MP cutoffs and used multivariable regression to determine the association between MP categories on ICU mortality, 28-day ventilator-free days (VFDs) and ICU-free days (IFDs), adjusting for the Pediatric Index of Mortality 3 score, Pediatric Logistic Organ Dysfunction 2 score, oxygenation index (OI), and age. Causal mediation analysis was performed to estimate the causal effect of MP on outcomes treating oxygenation impairment (represented by OI) as mediator and age as a confounder. Results: A total of 466 patients were included for this analysis. Cutoffs for low, moderate, and high MP were < 0.2262 J/min/kg, 0.2262 to 0.4487 J/min/kg, and > 0.4487 J/min/kg, respectively. High vs low MP was associated with reduced VFDs (adjusted incidence rate ratio, –0.22 [95% CI, –0.35 to –0.10]; P < .001) and IFDs (adjusted incidence rate ratio, –0.14 [95% CI, –0.27 to –0.01]; P = .034), but not ICU mortality. In the causal analysis, OI showed a significant indirect effect on the causal pathway of MP on VFDs (indirect effect, –4.30 [P < .001]; direct effect, –1.17 [P = .635]; total effect, –5.47 [P = .024]) and IFDs [indirect effect, –3.13 [P < .001]; direct effect, –0.72 [P = .635]; total effect, –3.84 [P = .024]), but not ICU mortality. Interpretation: In this study, higher MP was associated with fewer VFDs and IFDs. The causal effect of MP on VFDs and IFDs was mediated fully by the impairment in oxygenation.http://www.sciencedirect.com/science/article/pii/S2949788425000358mechanical powermechanical ventilationpediatric ARDSventilatorventilator-induced lung injurypediatric intensive care unit |
| spellingShingle | Herng Lee Tan, MSc Rehena Sultana, MSc(stat) Phuc Huu Phan, MD Muralidharan Jayashree, MD Hongxing Dang, MD Soo Lin Chuah, MBBS Chin Seng Gan, MBBS Siew Wah Lee, MD Karen Ka Yan Leung, MBBS, MSc Ellis Kam Lun Hon, MBBS, MD Xuemei Zhu, MD Pei Chuen Lee, MMed(Paeds) Chian Wern Tai, MD Jacqueline Soo May Ong, MB BChir Lijia Fan, MD Kah Min Pon, MD Li Huang, MD Kazunori Aoki, MD Hiroshi Kurosawa, MD, PhD Rujipat Samransamruajkit, MD Jia Yueh Chong, MD Felix Liauw, MD Nattachai Anantasit, MD Wei Xu, MD Chunfeng Liu, MD Jan Hau Lee, MBBS Louise Ngu, MB BCh BAO Yek Kee Chor, MD Suparyatha Ida Bagus Gede, MD Dyah Kanya Wati, MD Judith Ju Ming Wong, MB BCh BAO The Impact of Mechanical Power Normalized to Predicted Body Weight on Outcomes in Pediatric ARDSTake-Home Points CHEST Critical Care mechanical power mechanical ventilation pediatric ARDS ventilator ventilator-induced lung injury pediatric intensive care unit |
| title | The Impact of Mechanical Power Normalized to Predicted Body Weight on Outcomes in Pediatric ARDSTake-Home Points |
| title_full | The Impact of Mechanical Power Normalized to Predicted Body Weight on Outcomes in Pediatric ARDSTake-Home Points |
| title_fullStr | The Impact of Mechanical Power Normalized to Predicted Body Weight on Outcomes in Pediatric ARDSTake-Home Points |
| title_full_unstemmed | The Impact of Mechanical Power Normalized to Predicted Body Weight on Outcomes in Pediatric ARDSTake-Home Points |
| title_short | The Impact of Mechanical Power Normalized to Predicted Body Weight on Outcomes in Pediatric ARDSTake-Home Points |
| title_sort | impact of mechanical power normalized to predicted body weight on outcomes in pediatric ardstake home points |
| topic | mechanical power mechanical ventilation pediatric ARDS ventilator ventilator-induced lung injury pediatric intensive care unit |
| url | http://www.sciencedirect.com/science/article/pii/S2949788425000358 |
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